The role of residual inflammatory risk and LDL cholesterol in patients with in-stent restenosis undergoing percutaneous coronary intervention.

• Evidence before this study. • Previous studies have demonstrated the association between residual inflammation and adverse clinical outcomes in patients with de novo lesions treated with PCI and statins. However, in patients with ISR, whether clinicians should choose a second LDL-C lowering agent, or alternatively initiate the anti-inflammatory therapy, remains uncertain and controversial. • Added value of this study. • Among 2079 patients who were undergoing PCI for ISR lesions, residual inflammatory risk (as measured by hsCRP) was a stronger predictor of adverse cardiovascular outcomes compared with residual cholesterol risk (as detected by LDL-C). • Implications of all the available evidence. • In patients with ISR underwent successful PCI, inflammation appears to be a stronger driver of residual cardiovascular event than cholesterol level. These data have substantial implications for the anti-inflammation as a therapeutic target to improve long-term outcomes in this special population. To evaluate the relationships between residual inflammatory risk [assessed by high-sensitivity C-reactive protein (hsCRP)], residual cholesterol risk [assessed by low-density lipoprotein cholesterol (LDL-C)] and clinical outcomes among patients who underwent percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) lesions. Between January 2017 and December 2018, a total of 2079 patients who underwent PCI for ISR were consecutively enrolled. The primary outcome was the rate of major adverse cardiac events (MACE), defined as a composite endpoint of all-cause death, spontaneous myocardial infarction (MI), or repeat revascularization. During a median follow-up of 36 months, 436 MACEs occurred. Baseline hsCRP was significantly associated with MACE (highest versus lowest quartile, adjusted hazard ratio [aHR] 1.90 [95% CI, 1.39–2.59]; P < 0.001). By contrast, the baseline LDL-C quartile was not associated with MACE (highest versus lowest quartile, aHR 0.93 [95% CI, 0.71- 1.22]; P = 0.59). Compared with patients without residual risk (hsCRP <2 mg/L and LDL-C < 70 mg/dL), participants with both residual inflammatory and LDL-C risk (hsCRP ≥2 mg/L and LDL-C ≥ 70 mg/dL) (aHR, 1.39 [95% CI, 1.06–1.83]; P = 0.02) and those with residual inflammatory risk only (hsCRP ≥2 mg/L and LDL-C < 70 mg/dL) (aHR, 1.34 [95% CI, 1.01–1.72]; P = 0.04) had significantly higher risks of MACE. In the current cohort of patients after ISR PCI, inflammation assessed by hsCRP predicted higher risk of adverse clinical outcomes, whereas the level of LDL-C was not associated with adverse prognosis. [ABSTRACT FROM AUTHOR]